Diversity in Nursing: Finding Best Practices

by Grace Yang

I am an ICU nurse at a large metropolitan hospital here in the Seattle area. Before I go into work, I try to prepare myself for the demanding shift that lies ahead. This may include caring for a child that has a head injury and doing neuro checks every hour, doing wound care and making sure the patient is as comfortable as possible, supporting the family by explaining what I am doing and what care I am providing to their family member, explaining the different procedures that the patient may have to go through and the reason why, and possibly mentoring a new nurse in the process. The level of complexity increases when my “standard nursing care” is for patients and their families who are unable to communicate their needs effectively due to physical, cultural, or language differences. Attracting nurses from diverse backgrounds is essential to the future of nursing given the growing diverse populations that we care for.

For example, an event that recently happened at work involved a rapid response call from the acute care floor to the ICU. The patient was a young woman from a French-speaking region in Africa. She was approximately 5-6 months pregnant and had been admitted for continued nausea/vomiting for the past week. When I arrived to assess her, she had been pointing to her mid chest repeatedly and moaning/crying out in pain. The acute care nurse and the charge nurse were in the room, attempting to place IVs, do an EKG, and send labs to check for a cardiac event per the doctor’s orders since the patient was complaining of chest pain. The patient was highly distressed with the invasive procedures that were being done, and it was clear that she needed an explanation of what we were doing and what was going on. I used to work on the acute care floor the patient was currently on, so I knew that there was a nurse working that night that came from the same region as this patient and spoke the same language as her. I asked him to come in and help interpret her needs, and what he said made the nurses and the doctors stop what they were doing. He explained that she was pointing to her upper GI area, in the middle of her chest, but it was gastric pain she was complaining of not chest pain. Once she was able to express her needs, we were able to treat her symptoms appropriately and decrease much of her distress and anxiety. We were lucky to have a nurse who was from the same region as the patient that could communicate with her effectively.

Language is not the only barrier I’ve come across with nursing diverse populations. We recently took care of siblings from Israel whose family practiced orthodox Judaism. They were here to undergo a complex neurosurgical procedure that was necessary for life. Not only did we need an interpreter, but we also had to be familiar with their Sabbath practices, their food preferences, and their ideas on personal space. We were again, fortunate to have a nurse who was familiar with orthodox practice, and could assist us in trying to better care for these patients. Having a diverse nursing workforce allowed us to give care that was appropriate and safe to our diverse patient populations.

At a recent Washington Center for Nursing Board meeting, we discussed the question of diversity in nursing and were asked to reflect on our own experiences and to look at the institutions we work for and how we lead to improve the diversity of our workforce. Bringing best practice regarding diversity to nursing is at the forefront of our ideas. We discussed successes, such as having a mentor/mentee committee and actively trying to pair people of similar ethnicities with each other on the units they work for, and the minority mentorship programs at the different universities that allow college students to go into high schools and tutor minority students so that they can be better supported academically. We were also asked to look at the makeup of our different organizations and see how many persons of color were in leadership positions or in middle management as well as ask the question if there were programs in place that allowed for the mentoring or education/leadership development of people of color who were in nursing or interested in nursing in our different institutions. The answers were definitely mixed.

What have you experienced at your institution that has helped increase diversity in the nursing workforce or improve diversity for the future nursing workforce?

Grace Yang RN, BS is a Washington Center for Nursing Board member and a staff nurse at Harborview Medical Center, Seattle.